MEDICARE: DR. JOHN THOMAS MORANVILLE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0802X	Addiction Psychiatry Physician	CA045114	CA
2	2084P0802X	Addiction Psychiatry Physician	2012-00239	NC

General Provider Information

NPI Number	:	1730183641
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN THOMAS MORANVILLE MD

Provider Business Mailing Address
First Line	:	302 PENNY LN
Second Line	:
City	:	MOREHEAD CITY
State	:	NC
Zip	:	28557-4306
Country	:	US
Telephone Number	:	415-819-5740
Fax Number	:	910-938-1118

Provider Business Practice Location Address
First Line	:	302 PENNY LN
Second Line	:
City	:	MOREHEAD CITY
State	:	NC
Zip	:	28557-4306
Country	:	US
Telephone Number	:	415-819-5740
Fax Number	:	910-938-1118

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/08/2005
Last Update Date	:	03/07/2023

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